Provider Demographics
NPI:1518034156
Name:ROBERT P HENDRIKSON MD PC
Entity Type:Organization
Organization Name:ROBERT P HENDRIKSON MD PC
Other - Org Name:HAND AND REHABILITATION SERIVCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HENDRIKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-755-9166
Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-755-9166
Mailing Address - Fax:203-755-5932
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-755-9166
Practice Address - Fax:203-755-5932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT P HENDRIKSON MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003293261QR0400X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation